PP19 Beyond first pass success: implementing DASH-1A for improved outcomes

<h3>Background</h3> First pass success (FPS) intubation rate is an important clinical performance metric, but it lacks patient-centred focus. FPS does not consider other important aspects of pre-hospital emergency anaesthesia (PHEA) including peri-intubation hypoxia and hypotension which are associated with worse outcomes. A metric which includes these variables is DASH-1A (Definitive Airway Sans Hypoxia/Hypotension on First Attempt). This metric incorporates the absence of hypoxia and hypotension as additional criteria for success in Pre-hospital Emergency Anaesthesia (PHEA). Several organisations have previously published DASH-1A results ranging from 45% to 79%. This study aimed to review our performance using both FPS and DASH-1A metrics over one year, highlighting the potential for improved outcomes through optimised practices and drug dosing. <h3>Methods</h3> A retrospective database review was conducted, examining drug assisted intubations over one year. All PHEAs were individually reviewed and both FPS rate and DASH-1A metrics were calculated. DASH-1A success was defined as intubation on the first attempt, systolic blood pressure (SBP) ≥ 90 mmHg and SpO2 ≥ 90% for 10 minutes following intubation (without pre-existing hypoxia or hypotension). Drug dosing including rocuronium was also reviewed. <h3>Results</h3> Out of 118 adult patients, 25 cases with pre-existing hypoxia or hypotension were excluded. FPS rate was 83% with a DASH-1A of 67%. The average rocuronium dose was 1.1mg/kg. Increasing rocuronium dose was associated with reduced hypoxia and hypotension. <h3>Conclusion</h3> The FPS and DASH-1A metrics were within the published range for PHEA, however there is scope for improvement. Recent publications suggest that higher rocuronium doses (1.4-2 mg/kg) enhance FPS rates without increasing adverse events. We are therefore implementing an increased rocuronium dose (2 mg/kg, up to a maximum of 150 mg) with a view to improving both FPS and DASH-1A metrics.